AB1404 ELECTRONIC CONSULTATION: A USEFUL TOOL TO OPTIMIZE THE ON-SITE MEDICAL CONSULTATION IN RHEUMATOLOGY
Authors: D. V. Mendoza Mendoza, D. Ruiz-Montesinos, V. Moreira Navarrete, J. J. Pérez Venegas
Journal: Annals of the Rheumatic Diseases (2022)

Background Electronic consultation (e-Consults) is a form of telemedicine. It permits communication between primary health care (PHC) and hospital care (HC). It is proving to be a helpful tool to reduce waiting times in consultations, to prioritize those pathologies that require an on-site consultation and also to avoid unnecessary travel for the patients (1). Objectives To evaluate the efficacy of e-Consults to avoid on-site consultations To evaluate the usefulness of e-Consults as a screening tool for on-site consultations To analyze the most frequent reasons for consultation To evaluate the evolution of e-Consults from the first to the second year of its implementation Methods Retrospective, observational study of all e-Consults carried out during 2021 in the hospital area Virgen Macarena , which includes 47 PHC centres. E-Consults were carried out by the tool “Plataforma de Teleconsultas del Servicio Andaluz de Salud” (teleconsultation platform of the Andalusian health service) as a clinical extension of the research project E-Hermes for the implementation of e-Consults. It collects information about the reason for the consultation, the suspected diagnosis of the rheumatologist, the response time of the TC and whether the consultation is completely resolved online (DISCHARGE), whether on-site consultation is required (CONSULTATION) or whether the patient needs further e-Consults in order to obtain more medical tests or to evaluate the treatment (FOLLOW-UP) The e-Consults of 2021 were compared to those of the previous year. Results Of the 733 e-Consults examined, 610 (83.2%) were fully resolved online and 123 (16.8%) required on-site consultation. Of those fully resolved online, 544 (89.2%) were resolved in the first consultation and 66 (11.8%) required more than one e-Consults. The most common reasons for consultation in this group of e-Consults were: suspected diagnoses of osteoporosis (19.1%), polyarthralgia (14.4%), questions about follow-up patients in Rheumatology (9.4%), joint swelling (7%), hand pain (6.8%) and questions about laboratory or imaging tests (3.9%). For 28% of patients, a rheumatic disease could be excluded, and for those patients who were diagnosed with a rheumatic disease, the most frequent diagnosis was: osteoarthritis 17.3%, osteoporosis 14.4%, fibromyalgia 8.3% and gout 3%. Of the patients that were recalled for an on-site evaluation, in 101 of the cases (90%) this decision was taken after the first e-Consults, while 11 patients (10%) were recalled after subsequent e-Consults. Among the patients recalled for an on-site visit, the most common reason was joint inflammation (23.4%), followed by polyarthralgia (22.1%), osteoporosis (18.2%) and hand pain (7.8%). The most frequent suspected diagnosis was inflammatory rheumatic disease (RA, PsA, SpA) in 49.4% of cases, followed by osteoporosis (24,4%) The average response time of the e-Consults was 82 hours (3 days and 10 hours) Compared to the e-Consults in 2020, it increased by 34%, 186 e-Consults more. The number of cases resolved without on-site consultation was 29% higher than in the previous year, while the e-Consults that required follow-up decreased by 7% and the number of patients that required further on-site consultation also decreased by 11%. The reasons for the consultation and suspected diagnosis were similar in both years. Conclusion E-Consults has proved efficacious, avoiding the necessity for on-site consultations in more than 80% of the patients. E-Consults helps to reduce on-site referrals to Rheumatology. E-Consults is effective in reducing waiting times before obtaining an evaluation from the rheumatologist and in prioritizing those patients who need on-site consultation. There are certain pathologies that are especially amenable to resolution without on-site consultation, like osteoarthritis, osteoporosis and fibromyalgia Over time, e-Consults is being integrated in the clinical practice of both the primary care physician and the rheumatologist and is becoming ever more efficient. References [1]Reumatol Clin. 2016;12(1):11–14 Figure 1. Disclosure of Interests None declared